Reimbursements made by insurance companies

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Reading Urology has a contract directly with its patients and expects all fees to be met. If you intend to claim using a health insurance policy you should contact the insurance company prior to each appointment to determine that your level of cover is adequate to meet the costs that will be charged.  We will always do our best to provide you with an idea of what charges may be made if asked.

You should also make us aware of any special conditions that may be applicable to your policy (e.g. 6 week clauses).

Benefits paid by health insurance companies vary and your insurance company may not cover all the components that may form part of your treatment. Common causes of benefits falling short are given below.

If you have any concerns about whether you will be covered for all costs please ask us for a price so that you can consult your insurance company before beginning your treatment.

Policy excess

Many people will have an excess on their policy. This may be your personal choice, or part of a company scheme. You may usually find that your premiums are reduced.

Some excesses are charged per incident i.e. if you are seeing two consultants for different problems (e.g. an orthopaedic surgeon and an urologist) you will have to pay your excess per speciality.

It is however more likely that you will have an annual excess, like a car insurance policy. This excess becomes payable against the first invoice(s) that your insurance company assess during your own policy year. It is possible that you could have to pay us the excess amount twice if your treatment runs over two separate years of your policy.

Co-insurance liability

Some policies carry a co-insurance liability which means that the patient must pay a certain percentage of each invoice.

Items not covered by your policy

Some patients reduce their premiums by paying for parts of their treatment themselves. For example, they could choose to pay for all their consultations or all out-patient treatment. 

Pre-existing conditions

Insurance companies will not usually provide cover for pre-existing conditions.

Benefit limitations

Some insurance providers may place limits on what the policy will pay for various parts of your treatment. For example, there may be a limit on the amount available for out-patient treatment. Once this limit is reached you will be come liable for any further costs during that policy year.

Procedure shortfalls

Each health insurance provider sets it own reimbursement criteria and some will cover our charges in full and some will not.  Most shortfalls are in the region of 10-15% of the invoice value, but this will depend on who your insurer is and the terms of your own policy. Some examples of shortfalls are given below.

Shortfalls in reimbursements made by insurance companies occur for any number of reasons, largely dependent upon the insurance company and your own policy terms and conditions. Payment for any shortfall is the responsibility of the patient, or their parent or guardian.

If you are concerned about how much a shortfall will be we can provide a guide price for your treatment and you can then check with your own insurance provider to see what they will be able to pay. 

We will always notify you of any shortfalls as soon as we are told by the insurance company, and how to pay us. You may also be notified by the insurance company directly.


If you have any questions about our invoicing, or feel that you may have trouble in paying us any money owing, please contact our Business Manager, Julia Rahman, 0118 902 8097 as soon as possible.